PLEASE NOTE: This blog post discusses treatment(s) for OCD that are still currently being researched. While there is evidence to suggest that they could potentially be helpful in reducing OCD symptoms, they are not concretely proven to do so as of the time of posting. These should be utilized as a last resort when all of the evidence-based treatment methods for OCD have already been accessed. For more information on evidence-based treatment methods for OCD, please click here.
By Gérard Castagné
It all started innocuously enough. I was experiencing some trouble with my teaching. School kids were hard to manage. So, I began to seek ways to make my teaching and my life more bearable. First, it was few hours in my free time. Then, I noticed that my search was becoming “sticky”. I had difficulty to pull away from it. If an idea came to my mind in the middle of the night, I had to sneakily get up (so my wife would not ask me questions) and note it on a piece of paper for fear of losing it when I woke up in the morning. Even the preparation work I had to do on the weekend to be ready for my teaching week was postponed and I spent the time instead exploring ways to better cope at work and in life in general. “This time I’ll find what I’m looking and still have time to be ready for my work week on Monday”, I was telling myself. But Monday came, and I didn’t find what I was looking for and was not ready for my work week. This repeated itself innumerable times.
At one point I had to do some repair work in my house that could not wait. Instead of welcoming the project I resented it because it would take time away from my search. However, I couldn’t stand the thought of my wife calling a professional to do a work I could do myself, of my irrational behavior becoming obvious to everybody, and, at the same time, I felt unable to face what was expected of me. I couldn’t keep it a secret any longer. So, finding myself at the end of my rope, I decided to turn to therapy.
Wanting to do everything myself, it had to be self-help therapy. I started to read books and I quickly realized that I unknowingly fell victim to OCD. I tried the proposed treatments. First, I denied my intrusive thoughts any meaning, but they kept roaring in my head. Then I attempted to prove that nothing bad would happen if I lead a normal life, but the uneasiness persisted. What if I missed a crucial idea by giving up my search? I told myself to stay anchored in the “here and now” and forsake the “what if” questions like inference-based CBT advocates. It’s true, you can’t help but wonder about the possible consequences of a decision in a domain that is important to you, but how not to be entrapped in your wondering to the point of neglecting the rest of your life and making it worse?
That's when I started to “see the light”. I came to the conclusion that it was a question of chronic indecisiveness in regard to my search for a better life. I couldn’t decide: I didn’t want to give up my search, I didn’t want it to consume my life, so I counted on an unreachable goal, the elimination of all doubts, to be able to return to a normal life. Life is full of difficult decisions that need to be made within certain time limits. Should I let my leg be amputated and avoid the risk of a deadly infection, or should I keep it and take my chances? When should I stop investing time and effort in the search for my lost child? Should I undergo conventional cancer treatment or choose a less common and more promising approach?
If one seeks absolute certainty in order to make up one’s mind, one is bound to be engulfed in OCD because as time passes, pressure to reach an ever-elusive inarguable conclusion mounts and one is stuck in one’s wondering. Like ICBT says, before making a tough choice conscientious people will naturally examine all of its possible consequences, but at one point they need to STOP doing it and follow the path that they judge best given the information available at the time and the time constraints. This ensures one’s self-esteem is preserved should the worst happen.
Regaining control of one’s life is not easy work because, as ICBT states, the more one values a certain outcome, the more difficult it is to end the checking or the wondering concerning that outcome. For instance, a person checking the safety of the knot attaching their feet to a bungee cord will not give up their checking as easily as one checking the knot tying a hook to their fishing line, unless their survival depends on catching a fish.
The “contingency mañana ploy” concept presented by Bill Knaus  was also a factor in my recovery. It warns against the danger of making the completion of a task-dependent upon the obtention of results you have no control over.
For instance, telling yourself “I’ll start the house renovations that need to be done when my quest for a better life is over” is a doomed undertaking from the start. As there are always new information and possibilities, it’s never over, and despite that, you need to persist in your quest because you don’t see any other way to turn again your attention to practical matters.
In my opinion, ICBT is not fundamentally different from ERP. Not really because in both therapies you need to stop indulging in OCD thoughts or reasoning. The difference is that with ERP you stop because this allows you to get used to some degree of uncertainty, which takes the edge of anxiety. With ICBT you stop because you want to stay grounded in reality and escape the “OCD bubble”.
Either way they are great therapies that make you aware of the dangers of endless checking or deliberating, prompts you to set limits to any search for greater certainty, and restores your faith in your decision-making abilities. Both highlights the illusion OCD sufferers are often victim of: they wrongly think that they can come to a conviction beyond all doubts, reasonable or not, by engaging in more obsessional doubts or that they can obtain sustainable peace of mind by carrying on more out-of-control reassurance-seeking strategies.